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# Brimonidine ## Overview Brimonidine is a selective alpha-2 adrenergic agonist. It works by decreasing aqueous humor production and increasing uveoscleral outflow. ## Primary Indications * Ophthalmic: Glaucoma, Ocular hypertension. ## Adult Dosing * Ophthalmic: 1 drop in the affected eye(s) 2 or 3 times daily, approximately 8 hours apart. Use the lowest effective dose. ## Pediatric Dosing * Ophthalmic: Safety and efficacy not established. In postmarketing reports, pediatric patients (especially neonates and infants <2 years) have experienced increased sedation, somnolence, hypotonia, pallor, and respiratory depression. Careful consideration and potential dose reduction are warranted if used in this population. ## Dose Adjustments * Renal Impairment: No specific dose adjustment recommended, but use with caution. * Hepatic Impairment: No specific dose adjustment recommended, but use with caution. ## Contraindications * Hypersensitivity to brimonidine. * Neonates and children <2 years of age receiving systemic or ophthalmic brimonidine due to increased risk of adverse effects. * Patients currently receiving MAO inhibitors or within 14 days of discontinuing MAO inhibitors. ## Adverse Effects * Ophthalmic: Allergic conjunctivitis, conjunctival hyperemia, eye dryness, burning, stinging, foreign body sensation, fatigue, headache, somnolence. * Systemic absorption can lead to adverse effects such as dry mouth, fatigue, dizziness, and somnolence. ## Key Drug Interactions * MAO inhibitors: May potentiate the pressor response. * CNS depressants (e.g., alcohol, barbiturates, opioids, sedatives, anesthetics): May cause additive CNS depressant effects. * Antihypertensives: May have additive hypotensive effects. ## Monitoring * Intraocular pressure (IOP). * Signs and symptoms of systemic absorption, especially in pediatric patients. * Allergic reactions. ## Clinical Pearls * Brimonidine can cause somnolence. Advise patients to use caution when driving or operating machinery. * For ophthalmic use, the preservative benzalkonium chloride can be absorbed by contact lenses. Discontinue contact lens wear during treatment. * Systemic absorption is possible and can be more pronounced in pediatric patients, particularly neonates. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and professional guidelines before making clinical decisions. Dosage and recommendations may vary based on individual patient factors and local protocols.